A Possible Role of ID-Migraine™ in the Emergency Department: Study of an Emergency Department Out-Patient Population

Cephalalgia ◽  
2009 ◽  
Vol 29 (12) ◽  
pp. 1326-1330 ◽  
Author(s):  
C Mostardini ◽  
VC d'Agostino ◽  
DE Dugoni ◽  
R Cerbo
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
High Sensitivity ◽  
High Specificity ◽  
Primary Headache ◽  
Rapid Diagnosis ◽  
Secondary Headache ◽  
Not Otherwise Specified ◽  
Id Migraine

Headache symptoms account for 1-3% of admissions to an emergency department (ED). Most patients affected by a primary headache (PH) have migraine, although they are often misdiagnosed as ‘headache not otherwise specified’. We investigated the possibility of using ID-Migraine (ID-M) to improve migraine recognition in the ED setting. We planned a pilot study involving ED out-patients with a diagnosis of PH. Diagnoses of a blinded headache expert were subsequently matched with the ID-M results. We tested ID-M on 230 patients (199 PH, 31 secondary headaches). Considering only PH, ID-M exhibited a sensitivity of 0.94 and specificity of 0.83 with a positive predictive value (PPV) of 0.99. The ID-M is a simple migraine screener with high sensitivity, high specificity and high PPV, even in an ED-derived population. Methodical use of this tool in an ED setting may, once a secondary headache has been excluded, lead to rapid diagnosis of migraine.

scholarly journals Iatrogenic bacterial meningitis: an unmasked threat

CJEM ◽  
2012 ◽  
Vol 14 (04) ◽  
pp. 263-266 ◽  
Author(s):  
Robert Barnwell ◽  
Vincent Ball
Keyword(s):  
Emergency Department ◽  
Bacterial Meningitis ◽  
Spinal Anesthesia ◽  
Lumbar Puncture ◽  
Epidural Anesthesia ◽  
Emergency Physician ◽  
Rapid Diagnosis ◽  
Treatment And Prevention ◽  
Sterile Technique

ABSTRACT Iatrogenic bacterial meningitis (IBM) is a rare but serious complication of neuraxial procedures, such as spinal and epidural anesthesia or lumbar puncture. We report a case of a 46-year-old female who presented to the emergency department with bacterial meningitis after spinal anesthesia. We reviewthe existing literature outlining the pathogenesis, vector hypothesis, diagnosis, treatment, and prevention as they relate to IBM. We highlight the role of the emergency physician in the rapid diagnosis of this disease, and underscore the need for sterile technique when performing lumbar punctures.

scholarly journals Low-Cost and Scalable Platform with Multiplexed Microwell Array Biochip for Rapid Diagnosis of COVID-19

Research ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Yang Wang ◽  
Kaiju Li ◽  
Gaolian Xu ◽  
Chuan Chen ◽  
Guiqin Song ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Reverse Transcriptase ◽  
Low Cost ◽  
High Sensitivity ◽  
High Specificity ◽  
Rapid Diagnosis ◽  
Negative Patient ◽  
Microwell Array ◽  
Custom Made ◽  
User Friendly

Sensitive detection of SARS-CoV-2 is of great importance for inhibiting the current pandemic of COVID-19. Here, we report a simple yet efficient platform integrating a portable and low-cost custom-made detector and a novel microwell array biochip for rapid and accurate detection of SARS-CoV-2. The instrument exhibits expedited amplification speed that enables colorimetric read-out within 25 minutes. A polymeric chip with a laser-engraved microwell array was developed to process the reaction between the primers and the respiratory swab RNA extracts, based on reverse transcriptase loop-mediated isothermal amplification (RT-LAMP). To achieve clinically acceptable performance, we synthesized a group of six primers to identify the conserved regions of the ORF1ab gene of SARS-CoV-2. Clinical trials were conducted with 87 PCR-positive and 43 PCR-negative patient samples. The platform demonstrated both high sensitivity (95.40%) and high specificity (95.35%), showing potentials for rapid and user-friendly diagnosis of COVID-19 among many other infectious pathogens.

scholarly journals Microwave scan and brain biomarkers to rule out intracranial hemorrhage: study protocol of a planned prospective study (MBI01)

2021 ◽  
Author(s):  
Tomas Vedin ◽  
Henrik Bergenfeldt ◽  
Emanuel Holmström ◽  
Jakob Lundager-Forberg ◽  
Marcus Edelhamre
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Intracranial Hemorrhage ◽  
High Sensitivity ◽  
High Specificity ◽  
Signs And Symptoms ◽  
Emergency Department Care ◽  
Characteristics Analysis ◽  
Rule Out

Abstract Purpose The aim of this planned study is to evaluate the ability of a cranial microwave scanner in conjunction with nine brain biomarkers (Aβ40, Aβ42, GFAP, H-FABP, S100B, NF-L, NSE, UCH-L1 and IL-10) to detect and rule out traumatic intracranial hemorrhage in an emergency department setting. Traumatic brain injury is a world-wide topic of interest for researchers and clinicians. It affects 2% of the population per annum and presents challenges for physicians as patients’ initial signs and symptoms do not always correlate with the extent of brain injury. The gold standard for diagnosis of intracranial hemorrhage is head computerized tomography (CT) with the drawbacks of high cost and radiation exposure. A fast, secure way of diagnosing without these drawbacks has potential to make care more effective and reduce cost. Methods Study will be prospective and enroll adult, consenting patients with head trauma who seek emergency department care. Only patients where the treating physician prescribes a head-CT will be included. The microwave scan and blood sampling will be performed in close temporal proximity to the CT scan. Results will be analyzed with sensitivity, specificity and receiver operator characteristics analysis to provide the best combination of a number of biomarkers and the microwave scan. Conclusion This study will explore the diagnostic accuracy of a head microwave scanner in combination with biomarkers in ruling out intracranial hemorrhage in traumatic brain injury patients presenting to the emergency department. Potentially, this combined diagnostic approach could achieve both high sensitivity and high specificity, thereby reducing the need of CT-head scans when managing these patients. Clinicaltrials.gov identifier: NCT04666766. Registered December 11, 2020.

scholarly journals Headache in the Emergency Department in Chongqing Province, China: A Multicentre Study

2020 ◽  
Author(s):  
Qin Li ◽  
Tao Ye ◽  
Jingxi Ma ◽  
Dongli Yuan ◽  
Xuemei Peng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Headache ◽  
Secondary Headache ◽  
General Hospitals ◽  
Course Of Disease ◽  
Hospitalization Rates ◽  
Diagnosis Rate ◽  
Missed Diagnosis ◽  
Male Patients

Abstract Background: To investigate the present situation of emergency headache in many general hospitals in Chongqing Province, China.Methods: From January 1 to December 31, 2017, we studied patients who complained of headaches as the main symptom in the emergency department of 17 general hospitals in Chongqing Province. Each patient with a headache was interviewed and the medical history was collected by administering a questionnaire. The diagnosis of headache is based on the third edition of the International Classification of Headache Disorders (ICHD-3 beta). Results: In 2017, 16434 patients complained of headache in 17 general hospitals in Chongqing, accounting for 2.3% of all emergency patients. Eight thousand one male patients (48.7%) and 8433 female patients (51.3%) experienced a headache. The average age was (41.8 ± 13.2) years, and the course of disease was 3 hours to 15.2 years. Regarding the initial diagnosis, 7299 patients (44.4%) were diagnosed secondary headache, 5076 (30.9%) were diagnosed with primary headache and 4059 (24.865%) could not be diagnosed. The hospitalization rates for these patients were 60.3%, 12.2%, and 41.5%, respectively. Migraine is still the most common type of primary headache. Conclusions: This study shows that the misdiagnosis rate and missed diagnosis rate of patients with an emergency headache are high, and the emergency department still performs overtesting and hospitalizations.

scholarly journals Clinical availability of SNOOP4 in acute non-traumatic headache patients admitted to the emergency department

2020 ◽  
pp. 102490792092868
Author(s):  
Wachira Wongtanasarasin ◽  
Borwon Wittayachamnankul
Keyword(s):  
Emergency Department ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Primary Headache ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Sensitivity Specificity

Objectives: Non-traumatic headache accounts for up to 4.5% of all patients presenting to the emergency department. Non-traumatic headache is generally classified into two categories: primary and secondary headache disorders. Differentiating secondary from primary headache disorders is essential. SNOOP4 is known as a mnemonic for suggesting clinicians send neuroimaging to rule out serious conditions. Yet, the benefit of using this mnemonic in the emergency department is not well established. This study aimed to assess the significance of SNOOP4 in detecting serious causes of non-traumatic headache in adults presenting to the emergency department. Methods: We conducted a prospective observational study of adult patients presenting to the emergency department of the single tertiary hospital over a period of 12 months. Patients with acute non-traumatic headache presented at the emergency department were included. A standard record form was used. Patients were investigated and treated following the pre-existing protocols. Results were interpreted by attending radiologists. Each factor, according to SNOOP4, was then evaluated for the ability to predict serious causes of non-traumatic headache. Results: A total of 90 patients were included in this study with complete details obtained on 83 (92.2%) patients. Of these, 63 (75.9%) were female. The mean age was 44.5 years (inter-quartile range: 27–58.5). The duration of the headache ranged from 10 min to 7 days. Out of 83, 27 (32.5%) had at least one SNOOP4 criterion. In all, 25 patients (30.1%) underwent neuroimaging. The sensitivity, specificity, positive predictive value, and negative predictive value of SNOOP4 were 77.8%, 73.0%, 25.9%, and 96.4% respectively. Conclusion: SNOOP4 criteria show very high negative predictive value for excluding serious causes of acute non-traumatic headache in adult patients presenting to the emergency department.

scholarly journals Emergency Department Physical Therapist Service: A Pilot Study Examining Physician Perceptions

2010 ◽  
Author(s):  
Michele Lebec ◽  
Steven Cernohous ◽  
Lisa Tenbarge ◽  
Colleen Gest ◽  
Kristen Severson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Emergency Care ◽  
Qualitative Methodology ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Emergency Physicians ◽  
Physician Perceptions ◽  
Potential Benefits

Though physical therapist consultation has been described as a means of enhancing care in the Emergency Department (ED), such services are rare and often poorly understood. This pilot study utilizes qualitative methodology for the purpose of describing how one group of emergency physicians experienced with physical therapist consultation in the ED perceive these services and the challenges associated with their provision. Transcripts of interviews with 11 emergency physicians were analyzed for recurrent themes. Findings indicated that these physicians found ED physical therapist services to be of value for themselves, their patients, and the department as a whole and described specific manners in which such consultations enhanced emergency care. Implementation and maintenance of the program, however, presented various challenges. Furthermore, physicians perceived that possession of certain characteristics better prepared physical therapists for success in this practice environment. These findings may help clarify the role of the ED physical therapist and aid in communicating the potential benefits and complications associated with the delivery of such services.

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